Association Executive Directors Community

  • 1.  ACT PMPM Hour Targets in Your State?

    Posted 03-13-2023 15:52

    Hello Association Executives- 

    Please see the question below from Mark LeVota, Executive Director, District of Columbia Behavioral Health Association. 

    The DC Department of Behavioral Health and the DC Medicaid Authority have proposed moving our Assertive Community Treatment services to a Per Member Per Month.

    There's a hitch.

    The methodology proposed for billing requires a minimum of eight (8) hours of contact per consumer per month. This isn't the 'contacts' counting method that's common in many jurisdictions that use an ACT PMPM. It's truly a count of eight hours of contact 'or 32 contacts,' which just seems to be another way of calling for fee-for-service type fifteen-minute unit billing.

    Are you aware of any States that use an ACT PMPM with a minimum contact time requirement instead of a minimum number of contacts requirement?

    Thanks in advance,

    Mark



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    Keisha Pitts
    National Council for Mental Wellbeing
    Washington DC
    202-684-7457
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  • 2.  RE: ACT PMPM Hour Targets in Your State?

    Posted 03-13-2023 17:06

    Good Afternoon:

    Following this thread to see what pops up.  A PMPM approach for ACT has been proposed by our Medicaid agency for the coming budget year, but there has been little groundwork on establishing the methodology. 



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    Josh Evans
    President/CEO
    Illinois Association of Rehabilitation Facilities
    Springfield IL
    217-725-7859
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    Original Message


  • 3.  RE: ACT PMPM Hour Targets in Your State?

    Posted 03-14-2023 09:08

    MA pays for ACT (called PACT here) via enrolled day rate.  From Medicaid payer performance specifications: "PACT programs flexibly provide multiple contacts per week with Members. PACT services are assertive. Contact occurs as often as necessary to meet a Member's needs and with consideration to a Member's preference. Contacts may be as frequent as two to three times per day, 7 days per week, 365 per year. Many, if not all, staff share responsibility for addressing the recovery needs of all Members requiring frequent contacts. Each contact is purposeful and related to the Member's priorities as reflected in their treatment and recovery plans."  I do believe any of the health plans systematically monitor the number contacts or units of time.



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    Lydia Conley
    President/CEO
    Association for Behavioral Healthcare
    Natick MA
    508-647-8385
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    Original Message


  • 4.  RE: ACT PMPM Hour Targets in Your State?

    Posted 03-14-2023 13:54

    In Montana, we're on a per member per week count and it doesn't have to be contacts with the client; it can also be a team meeting that discusses the client. 

    "PACT teams may be reimbursed for the weekly rate for each PACT member when the team
    meets and completes a staff meeting log for each PACT member four days per week for each
    core PACT member"



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    Mary Windecker
    Executive Director
    Behavioral Health Alliance of Montana
    Missoula MT
    406-532-8996
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    Original Message


  • 5.  RE: ACT PMPM Hour Targets in Your State?

    National Council Staff
    Posted 03-14-2023 15:28

    Here in New Mexico, I negotiated two PMPM contracts for ACT, one with an MCO, the other with the City of ABQ. 

    I successfully prevented them requiring minimum contacts, but got them to require fidelity to the model, which in general requires a minimum of weekly contacts. 

    The important thing was for the rate negotiation to include both new, higher need ACT patients, as well as longer term more stabilized patients. Though NM doesn't prior auth ACT, I believe it was important in the model to ensure that ACT services were long term, without discharge after stabilizing. 

    If folks wanted to email me privately I can discuss the rates we negotiated in a more confidential conversation. 

    Thanks

    David J.Ley PhD. 

    Executive Director, New Mexico Solutions 

    Board Chair, Behavioral Health Providers' Association of New Mexico

    National Council Board Member

    ley-david@rvbh.com




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    Neal Comstock
    Director of Membership
    National Council
    NealC@TheNationalCouncil.org
    202 748-8793
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    Original Message


  • 6.  RE: ACT PMPM Hour Targets in Your State?

    Posted 03-15-2023 12:12

    In Florida, payment is triggered by enrollment in the FACT (or ACT team).  The minimum # of contacts for FACT is 1x per week, but there are no time or unit requirements. Additionally, FACT is now a Medicaid covered service but remains in Fee for Service and is not included in managed care.  There is a daily rate, and that rate can be billed daily, or rolled up to a weekly or monthly claims submission.  The daily rate was developed by a simple calculation of the monthly FACT allocation for the Medicaid compensable services divided by the number of days in the month.  Services not covered by Medicaid (housing, other incidentals) are billed to our SAMH state agency.

    We do not recommend this approach. The administrative burden of billing is enormous.

    Melanie Brown Woofter

    President and CEO

    Florida Behavioral Health Association

    P: 850.224.6048 | C: 850.567.1946



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    Melanie Brown-Woofter
    Florida Behavioral Health Association
    Tallahassee FL
    850-224-6048
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    Original Message